The Inpatient Influenza Immunization Initiative — Using Computerized Provider Order Entry to Improve Screening and Immunization Rates

1Beth Israel Deaconess Medical Center, Boston, MA
2Beth Israel Deaconess Medical Center, Boston, MA
3Beth Israel Deaconess Medical Center, Boston, MA
4Beth Israel Deaconess Medical Center, Boston, MA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 88

Background:

Annual influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications, which account for 200,000 hospitalizations and 36,000 deaths in the United States each year. Patients age 50 and over who are hospitalized during influenza season should be offered influenza vaccine before they are discharged. To facilitate this effort, we convened a multidisciplinary team to establish a computer‐based immunization protocol.

Purpose:

To identify and offer influenza immunization to all inpatients age 50 and over during influenza season, using a computerized provider order entry system.

Description:

In an effort to improve inpatient immunization rates, many hospitals have adopted pen‐and‐paper opt‐out strategies, to identify a subset of patients age 50 and over for influenza immunization. Our Influenza Workgroup, represented by nursing, medicine, pharmacy, and information systems, expanded this approach and set as our goal offering immunization to all inpatients over age 49 (not just those with pneumonia) throughout the 2007‐2008 influenza season, with concomitant electronic documentation of immunization status. Our cPOE system was programmed to identify all patients age 50 and over on hospital admission. Patients with documented contraindications or prior immunization during this season are automatically excluded from the protocol. Initiation of admission, transfer, or postoperative orders prompts ordering providers to sign an order activating the Influenza Immunization Protocol for all remaining eligible patients. This protocol then generates a medication administration record label for vaccine administration per protocol, as well as a visual nursing alert for a “pending immunization” on the nursing dashboard. The nursing staff was in‐serviced to screen patients for possible contraindications and to delay immunization for febrile and preoperative patients. All other patients are offered immunization. All documentation of immunization status is done by nursing within the immunization screen in our cPOE system. This includes date of administration, vaccine manufacturer and lot number, vaccination site and route, and names of those administering and ordering vaccine. If a vaccine is not given, the reason for nonreceipt is documented electronically and automatically updated in the patient's online medical record.

Conclusions:

Our protocol has resulted in increased screening and immunization rates for influenza vaccine for all inpatients age 50 and over during influenza season. Current rates approach 90% for this patient cohort, not just for those with pneumonia. The cPOE system flags all eligible patients, while excluding patients who have already been immunized, either as inpatients or as outpatients in our system. This has improved work flow and decreases the potential for providing multiple immunizations during a single influenza season.

Author Disclosure:

A. Carbo, none; K. Sulmonte, none; K. Cunningham, none; L. Hurst, none.

To cite this abstract:

Carbo A, Sulmonte K, Cunningham K, Hurst L. The Inpatient Influenza Immunization Initiative — Using Computerized Provider Order Entry to Improve Screening and Immunization Rates. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 88. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/the-inpatient-influenza-immunization-initiative-using-computerized-provider-order-entry-to-improve-screening-and-immunization-rates/. Accessed November 13, 2019.

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